Swelling Above Incision 1 Month After Tummy Tuck, Is this Normal? (photo)

Question

I had a TT about a month ago. I didn't have massive weight loss, lost about 50 pounds over a year or so, but there was loose skin from having 3 big babies too. I still have my drain in because I am draining over 20cc a day. I see my board certified PS on a regular basis. My concern today is the swelling above the TT incision. Is this normal? It feels like it's getting worse too.

Tom J. Pousti, MD · Answer

Thank you for the question.

	As always, it is best to be seen in person ( by your plastic surgeon) for precise diagnosis and treatment.

	Abdominal wall "swelling" after tummy tuck may be related to:
	1. Swelling in the soft tissues.  This may take several months to resolve and may worsen with increased activity  or at the end of the day.   Patience  is required to allow for resolution of the swelling. The swelling occurs because of the interruption of venous and lymphatic channels that occurs during the tummy tuck operation.
	2. Fluid accumulation in the space between the skin and the abdominal wall muscle.  this may consist of blood ( hematoma)  or serum (seroma).  This fluid accumulation can generally be diagnosed by physical examination ( occasionally ultrasound  may be helpful).  Treatment consists of aspiration;  several episodes of aspiration may be necessary. 
	3. Separation of the abdominal wall muscle repair may lead to a swelling/bulge appearance. This may be diagnosed on physical examination  with your surgeon examining you in different bodily positions. One of the steps of a tummy tuck procedure involves reapproximation (plication)  of the rectus muscles.  These muscles have spread apart during pregnancy and/or weight gain. Bringing them together again in the midline helps to &ldquo;tighten&rdquo; the abdominal wall as well as to narrow the waistline.
	4. Residual adipose tissue may be confused for swelling. Again this is most easily diagnosed by physical examination. Additional liposuction surgery maybe necessary to improve the results of surgery.
	Generally, it takes many months for swelling to resolve after tummy tuck surgery and it may take up to one year  (or greater)  a complete skin redraping  to occur.

	I hope this helps.

Vishnu Rumalla, MD · Answer

Thanks for your question.  Good job to you for closely following up with your surgeon.  I usually get drains out when the output is less than 30 cc/24 hours but we each have different criteria.  As for your swelling above the incision, it is still early after surgery and it is hard to know if it is tissue swelling or retained adipose tissue in the flap.  Next time you visit your surgeon ask he/she if they would reccomend more compression.

Steven M. Lynch, MD · Answer

Hi,  Yes, it is very common to have swelling after a tummy tuck at one month post op.  You really need to have 6 months to a year to see your final result so you need to be patient.  Stay close to your board certified plastic surgeon and they will guide you in the post op period.  You need to reestablish the circulatory system to the "redraped" upper abdominal tissue in order for it to act more normally.  Now you will have more swelling in the area above the incision than you will have 6-12 months post op.  You do have a reasonable amount of tissue above the incision and on the lateral aspects of your contours.  Sometimes, the thickness of the upper abdomen when redraped after the excision of the lower abdominal tissue is more than the thickness below the incision.  If there is a discrepancy between the two thicknesses, then you may need some type of touchup after the year period if it is there and it bothers you.  There is so much going on with you now with the drain in place etc (seems like it can be pulled to me....a drain never really goes to zero....if it does over a 24 hour period, it is plugged.  your drainage is minimal now) that the best advice to you is to stay close to your ps.....be patient...and watch the changes take place over the months.

James Knoetgen, III, MD · Answer

Hello Achilds. Yes, it is normal to have swelling one month after a tummy tuck. Most patients get very swollen after a tummy tuck, especially if liposuction is performed as well. The swelling (which is basically fluid) will settle to the lowest area, which is around the incision, so it's no surprise that this area seems the most swollen to you.

	The best way to treat it is by wearing your compression garment, massaging the area, limiting your activity while you're healing, and staying in close communication with your plastic surgeon.

	I hope this helps and wish you all the best!

Robert Brueck, MD · Answer

This is normal and given enough time will go down.Heat and massage would help it go down quicker.Also wearing some compression directly over the incision would help too.

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